Nutritional Assessment

Nutritional Status- influence by

Adequacy of food intake (Quality & Quantity) Physical Health

Aims of Assessment of Nutritional Status

To map out distribution and geography of nutritional disorder. To identify high risk groups with respect to nutritional vulnerability. To assess various epidemiological factors for nutritional deficiency. Make recommendations to rectify shortcomings leading to nutritional deficiency To project for financial allocations and budget for food materials at a large administrative level e.g. at the national level.

ANTHROPOMETRY

Body mass index as an indicator of body type

Anthropometric Tools
In clinical practice, the whole body indices are useful, but can be limited, as when a child has ascites, fluid retention, or a large solid tumor which can confound weight-based indices. The other alternatives are: 1.Mid upper arm circumference (MUAC) which is an index of protein/energy status 2.Skinfold thickness which is an index of fatness 3.Arm muscle circumference or area which are indices of muscle bulk (derived from the above 2).

Anthropometric Tools
Why do we need anthropometric measurements? 1) Sometimes, the severity of malnutrition cannot be immediately determined by clinical examination 2) To calculate doses of feeds and drugs 3) To monitor progress of treatment What measures are indicated? 1. Weight / Height (W/H): method of choice in all ages (except pregnant women) for acute severe wasting 2. Medium Upper Arm Circumference (MUAC): alternative method, good predictor of short term mortality. 3. BMI : In adults. Only recommended to classify chronic undernutrition & in some nutritional surveys

CMAM = Community-Based Management of Acute Malnutrition

Biochemical & Laboratory Method

Laboratory and Biological assessment

Hemoglobin estimation Useful index of overall nutritional status RBC count and haematocrit also important

Stool Stool for intestinal parasites H/o of parasites, dysentery, diarrhoea

Urine Albumin & Sugar

Biochemical test use in nutritional surveys

Nutrient Vitamin A Thiamine Method Serum retinol Thiamin pyrophasphate (TPP) stimulation of RBC trans-ketolase activity RBC glutathione reductase activity stimulated by flavine adenine Urin N-methyl nicotinamide Serum folate Red cell folate Serum Vit-B12 concentration Leucocyte ascorbic acid Prothrombin time S. Albumin(g/L) Transferrin(g/L) Thyroid binding pre-albumin (mg/L) Normal Value 20 mcg/dl 1.00 -1.23 (ratio)

Riboflvin Niacin Folate Vitamin B12 Vitamin-C Vitamin K Proteine

1.0-1.2 (ratio) Not very reliable 6.0 mcg/ml 160 mcg/ml 160mg/L 15 mcg/10(8) cells 11 -16 Seconds 36 20 250

Clinical Examination

Classification of Signs in Nutritional surveys

Not related to nutrition Alopecia, pterygium, pyorrhoea

Need further investigation Malar pigmentation, corneal vascularisation, geographical tounge

Known to be value Angular stomatitis, Bitot s spots, calf tenderness, absence of knee and ankle jerks (Beri-beri), enlargement of thyroid gland (Endemic goitre)

 Clinical signs drowbacks Malnutrition cannot be quantified Unaccompanied Lack of specificity

Dietary Survey

Dietary Survey techniques

Weighment of raw food
Weigh all food material-waste /discarded (7 days, One dietary cycle)

Weighment of cooked food Oral Questionnaire method

24 hrs recall
Mean intake Consumption unit

Ecological Studies

Ecological Factors
Food balance sheet Indirect method Per capita supply available Assess general pattern of food consumption

Socio-economic factors Family size, occupation, income, education, customs, Cultural pattern

Ecological Factors
Health and education Primary health care service Feeding and immunization programme

Conditional influence Parasitic, bacterial & viral infection ( Ecological Diagnosis)

Functional Indicators

Functional indices of nutritional status

System 1. Structural integrity Erythrocyte fagility Capillary fragility Tensile strength 2. Haemostasis Pro-thrombin time 3. Reproduction Sperm Count 4. Nerve conduction Nerve conduction Dark adaptation 5. Host defence Leucocyte chemotaxis L. Bactericidal capacity 6. Work Capacity Heart rate P/E, Fe P/E, Zn P/E, Fe, Se P/E, Vit. B1, Vit. B 12 Vit. A, Zn Energy, Zn Vit. K Vit.E, Se Vit. C Cu Nutrients

Vital Statistics

Mortality & Morbidity data

Mortality indicators Infant mortality rate Second year mortality rate Rate of low birth weight babies Life expectancy PEM Xerophthalmia Anemia Endemic goitre Measles Parasitic infestation Diarrhoeas

Morbidity indicators-